The Heinous Hobnail: A Case Report of the Rare Hobnail Variant of Papillary Thyroid Carcinoma.

The hobnail variant of papillary thyroid carcinoma (HVPTC) represents a distinctive and relatively rare histological subtype of thyroid malignancies. This variant is characterized by its unique cellular morphology with a hobnail appearance, that is, cells with apically positioned nuclei. There are other characteristics like micropapillary pattern and loss of cohesiveness of cells, which are indicative of HVPTC. It can be difficult to distinguish this pattern from other thyroid neoplasms; thus, a thorough microscopical examination is required. Thyroglobulin, thyroid transcription factor-1 (TTF-1), and other thyroid markers are commonly expressed by the tumor cells. Clinically, HVPTC is similar to conventional papillary thyroid cancer (PTC) in many aspects like incidence and epidemiology, but the former is associated with a worse prognosis. According to some research, the hobnail variety might behave more aggressively than conventional PTC, which highlights how crucial it is to identify and comprehend this distinct subtype. While the genetic and molecular underpinnings of HVPTC are still being elucidated, some studies have reported associations with specific genetic alterations, including BRAF, TP53, and TERT mutations. Investigating these molecular signatures may contribute to a better understanding of the variant's pathogenesis and potentially guide targeted therapeutic approaches in the future. In order to customize treatment plans, histopathology is essential in correctly diagnosing it. In this article, we present a case of PTC which presented as a solitary nodule on ultrasonogram in a 40-year-old female.

A Case of Leukemic Pleural Infiltration in the Blast Crisis Phase of Chronic Myeloid Leukemia: An Unusual Extramedullary Involvement.

The development of pleural effusion in chronic myeloid leukemia (CML) is not well-understood and rarely documented in literature. Extramedullary involvement (EMI), which occurs in about 10% of CML cases, typically affects lymph nodes and the spleen. Instances of extensive infiltration of leukemic cells into the pleura are infrequently reported in CML. Here, we report a case of 41-year-old man experiencing significant bilateral pleural effusion with leukemic infiltration during the blast crisis (BC) phase of refractory CML. Examination of the pleural fluid revealed cells with morphological characteristics of myeloblasts. Although very rare, pleural leukemic infiltration should be considered as a cause of pleural effusion in patients with CML, especially in the BC phase.

An Unusual Case of Hepatocellular Carcinoma in a Healthy Adolescent Male.

Hepatocellular carcinoma (HCC) is a rare occurrence in adolescents, especially in those without underlying liver diseases. We present the case of a 16-year-old male, having no significant relevant previous medical history, who presented with signs and symptoms of an abdominal mass and hepatic dysfunction. Diagnostic investigations unveiled a startling finding of HCC, challenging the conventional understanding of this malignancy's epidemiology and etiology in young individuals. This example emphasizes the significance of taking HCC into account even in young, healthy individuals who present with unusual symptoms, leading to a comprehensive diagnostic examination and treatment plans customized to meet the specific requirements of patients in their adolescent years. HCC is thought to be more likely to develop in young patients with cirrhosis or fibrosis. The patient in this case study is a young 16-year-old male patient, who was diagnosed with HCC.

Synchronous Gastric and Colonic Adenocarcinoma: A Case Report With its Molecular Implications.

Multiple primary tumors are rare but their incidence is increasing nowadays with advancements in diagnostic methods and the extended survival of individuals previously treated for malignancies. However, synchronous occurrence of gastric cancer (GC) and colonic cancer (CC) is a rare entity. A 41-year-old male came with complaints of epigastric pain associated with anorexia, rapid weight loss, and occasional constipation. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis reported mucosal thickening in the antrum, likely GC with circumferential wall thickening of the transverse colon with pericolic fat stranding suggestive of CC. Upper gastrointestinal endoscopy and colonoscopy were also done and a biopsy was taken from representative sites, which confirmed malignancy. He completed three cycles of chemotherapy preoperatively and underwent subtotal gastrectomy, D2 lymphadenectomy, gastrojejunostomy, jejunojejunostomy, and transverse colectomy simultaneously. Histopathological examination confirmed moderately differentiated gastric adenocarcinoma penetrating into the subserosa and well-differentiated colonic adenocarcinoma invading the muscularis propria. Immunohistochemical analysis of mismatch repair (MMR) proteins was done to determine the association with hereditary nonpolyposis colorectal cancer syndrome (HNPCC) or Lynch syndrome. The patient underwent postoperative chemotherapy along with immunotherapy. To conclude, synchronous occurrence of primary GC and primary CC with similar MMR protein expression in immunohistochemistry is an uncommon entity.

The Clinical Utility of Automated Immature Granulocyte Measurement in the Early Diagnosis of Bacteremia.

Background Early diagnosis and prompt management are crucial for bacteremia and sepsis, as they have the potential to lead to septic shock and fatal outcomes. Bacteremia induces the recruitment of immature granulocytes (IGs) into the circulation, which indicates active bone marrow response. The goal of our present study is to determine the effectiveness of automated IG measurement as an alternate indicator for infection and also its clinical utility in predicting positive blood culture (BC) results. Methods We conducted a retrospective study including 100 BC-positive patients for whom complete blood count (CBC) and BC were done at the same time. Multiple hematological parameters including total white blood cell count (TWC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), IG count (IGC), and IG percentage (IG%) were obtained from the automated hematology analyzer, and IGC/TWC (IG ratio), IGC/ANC (immature-to-total neutrophil ratio), and ANC/ALC (neutrophil-to-lymphocyte ratio) were calculated using the primary data and compared with 100 uninfected normal individuals. Results The mean value of IG% and IGC between culture-positive and culture-negative groups were statistically significant (p-value < 0.05), suggesting that they are potential markers for bacteremia, and also the IG% was significantly higher in patients with positive BCs. Conclusion IG measurement is an easily accessible, cost-effective potential marker for screening bacteremia. Therefore, IGC and IG% could be incorporated as a part of the CBC report.